Earlier recognition of glomerular disease may depend heavily on the clinicians patients see before reaching a specialist. With an estimated 200 glomerular disease specialists practicing across the US and Canada (and some patients living more than 200 miles from one), unexplained proteinuria or hematuria should prompt further evaluation even when kidney function remains relatively preserved. George Vasquez-Rios, MD, recommends considering urinalysis, renal ultrasound, and additional testing when no clear cause is apparent, followed by referral when glomerular disease remains a concern. The need is clinically important: patients managed without access to a glomerular disease specialist have been reported to undergo kidney biopsy and receive newer therapies less often, potentially contributing to delayed diagnosis and treatment.
The American Society of Nephrology’s Glomerular Diseases Collaborative Compendium is designed to support this recognition-to-referral process without replacing clinical guidelines. Resources help general clinicians determine which tests to initiate, when specialist input may be appropriate, and how to navigate increasingly complex therapies, including prior authorization, appeals, referrals, and documentation. Vasquez-Rios also emphasizes that consultation should not be viewed as a last resort as the therapeutic landscape becomes more specialized. The practical takeaway is to recognize unexplained urinary abnormalities early, initiate an appropriate workup, and use specialist and professional-community resources to help prevent geography or limited subspecialty access from delaying care.
Reference: Vasquez-Rios G. You don’t need to be a GN specialist to identify glomerular disease earlier. HCPLive. 2026 Sep 17.
